ETHICS  Morals are fundamental

standard of right or wrong,

 Comes from a Greek word learned & internalized in
"ethos* which means moral early childhood, often
duty. Literally, it means based on religious beliefs.
custom or particular
behavior. ETHICS & MORALS
 Means "character"
Ethics can be defined as a set of
 The principle of right or
principles that governs one's
good conduct
behaviour, whereas Morals relates
 Studies how people make
to an individual's character and own
judgment in regard to right
personal principles regarding right
or wrong.
and wrong (Collins, 2006).
 The philosophical study of
voluntary human acts with MORALITY
the purpose of determining
what good, right is and to Morality is concerned with knowing
be done, and what bad, and doing what is right. Morality is a
wrong and not to be done. code of values to guide man's
 Cafferty defines ethics as choices and actions
the study of standards of HEALTH CARE ETHICS
conduct and the moral
judgment and values upon A science that deals with the study
which these standards are of the morality of human conduct
based concerning health and health care.

Importance of ethics in nursing: Deals with the conduct and moral

Each person has their own set of issues that arise in the practice of
personal ethics and morals. Ethics health care professionals, nurses &
within healthcare are important midwives included.
because workers must recognize
healthcare dilemmas, make good
judgments and decisions based on It is concerned with health care
their values while keeping within the values,
laws that govern them
obligations, rights and needs. It
MORALS strives to resolve ethical issues that
often confront health care
 comes from Latin word
professionals
"mores", which means
customs or values. ETHICAL THEORIES
 Morals deal with the
conduct of man, the right Ethical theories. attempt to provide
and wrong behavior of man a system of principles and rules for
in his relationship with his resolving ethical dilemmas.
fellowmen.
These theories consist of are done from a sense of
fundamental beliefs about what is duty or reason
morally right or wrong - A follower of pure
deontology believes in the
1. Utilitarianism
absoluteness of principles
2. Deontology
regardless of the
UTILITARIANISM consequences of the
decision.
 Determines what is right or - According to this theory,
wrong based on an action's honouring ethical
consequences. obligations ensures good,
 Using this system, decision even though actions may
makers determine and be difficult and
choose those actions that consequences painful.
will result in the greatest
good for the greatest Virtues
number of people. are attitudes, dispositions, or
(happiness principle) character traits that enable us to be
 This theory accepts that if and to act in ways that develop this
the end justify the means, potential.
then it is right.
 Using this system, ethical •They enable us to pursue the
decisions most often are ideals we have adopted.
made through a process
*Examples of virtues: Honesty,
called risk-benefit analysis.
courage, compassion, generosity,
 It can be argued that some
fidelity, integrity, fairness, self-
individual rights can be
control, and prudence.
sarrificed for the sake of the
greater happiness of the Virtue ethics in nursing is
many. therefore concerned with the
character of individual nurse and
DEONTOLOGY
seek ways to enable nurses to
- Decision making is based develop character traits appropriate
on moral rules and for actions that enhance wellbeing.
unchanging principles that Ethical Dilemma
centers on duty and
obligation to others. An ethical dilemma is the choice
- Comes from a Greek word between two or more equally
"deon" meaning "duty"'. justifiable alternatives.
- Deontology emphasizes
Sometimes it requires an individual
moral obligation or
to make a choice between two
commitment.
equally unfavorable alternatives.
- A person is morally good
and admirable if his actions
The individual who must solve an 1. ALTRUISM is concern for the
ethical dilemma is the only person welfare and well being of others.
who can ascertain if actions taken Altruism is reflected by the nurse's
were congruent with personal concern and advacat for the welfare
values of patients, other nurses, and
healthcare providers. Health care
Ethical dilemma occurs because professional is obligated to attend
people have different ethical to the best interest of patients
philosophy, follows different rather than self interest.
philosophy in life and see life
situations at different perspectives. 2. Autonomy is the right to self-
determination, it is when the nurse
Values - comes from the Latin word
respects patients' rights to make
"valere" which means to be strong.
decisions about their health care
Indeed they are strongly held
3. Human Dignity is respect for the
beliefs or convictions about what a
inherent worth and uniqueness of
person holds to be important and
individuals and population. It is
worthy in his or her life.
reflected when the nurse values
Values are ideals and concepts that and respects all patients and
give meaning to an individual's life. colleagues.

Values are shaped out of society's 4. Integrity is acting in accordance

norms, religion and family with an appropriate code of ethics
orientation. Values are not and accepted standards of practice.
permanent characteristics; they It is when the nurse is honest and
may change for the better or for the provides care based on an ethical
worse. framework that is accepted within
the profession.
What is meant by "core values"
5. Social Justice is acting in
Core values are the values we put accordance with fair treatment
on regardless of economic status,
- Our work race, ethnicity, age, citizenship,
disability, or sexual orientation.
- Our clients
- Our Ourselves 6. Accountability is being
accountable to their patients, to
They can be central to the way we
society on issues of public health
give care and live our lives.
and to their profession.
CORE VALUES OF A
PROFESSIONAL NURSE 7. Excellence - nurses are
obligated to make a commitment
Core Values Of A Professional of life-long learning.
Nurse
8. Duty - should be available
and responsive, accepting a
commitment to service within the - Refers to the capacity of the
profession and the community. patient to accept or refuse
treatment.
9. Honor and Integrity - should
be committed to being fair,
truthful and straightforward in
a. INFORMED CONSENT. The
their interactions with patients and
respect for the autonomy of the
the profession.
patient means that the patient
10. Respect for others - should has the capacity to act
demonstrate respect for patients intentionally, with understanding,
and their family and to the other and without controlling
members of the health team. influences that would act against
a free and voluntary act such as
ETHICAL PRINCIPLES - are coercion or undue influence.
widely accepted codes generally
based on the humane aspect of The primary task of the health
society that direct or governs care provider is to inform the
actions. ETHICAL DECISIONS - patient or the persons
reflect what is best for the client responsible for the patient all the
and society information there is about the
options available
Importance: Ethical principles
can be used as guidelines in b. INFORMED CONSENT OF
analyzing dilemmas and can MINORS & MENTALLY
serve as justification (rationale) INCAPACITATED
for resolving ethical problems. Parents & guardians are the
1. PRINCIPLE OF AUTONOMY persons who have the authority
to give consent in behalf of
Autonomy - refers to the minors or children below 18
individual's right to choose and years old; and persons who are
the individual's ability to act on mentally incapacitated (insane,
that choice. unconscious, not of sound
mind).
Promotes self-determination/
freedom of choice However minors or children
below 18 years old can make
APPLICATION OF AUTONOMY
their own informed consent if
IN HEALTH CARE ETHICS:
they are already married.
a. INFORMED CONSENT.
C. PATERNALISM/
PARENTALISM. It means
acting in a fatherly manner
which involves engaging in who will make the
behavior associated with those medical decisions on
of the traditional roles of the behalf of the patient
father of a family such as when the latter is
leadership, decision making, incapacitated or in a
discipline and protection. condition where he is
unable to make such
d. STANDARD OF BEST
decisions.
INTEREST.
Forms of Advance Directive:
This pertains to health care
providers making decisions 1. LIVING WILL (Instructional
about a client's health care
Directive) - a will in which a
when they are unable to make
competent adult give directions
informed decisions about their
or instructions for future care in
own care.
the event that he becomes
In this situation, the health care incapacitated due to terminal
provider must decide what the illgess or impending death.
best course of action for the
2. MEDICAL POWER OF
patient is and carry it out.
ATTORNEY
e. ADVANCE DIRECTIVE. Is a
(Health Care Proxy) - names a
document where a person give
trusted person to act as an
instructions about future medical
agent or proxy in making health
care should he or she be unable
care decisions in the event of
to participate in medical
incapacity.
decisions due to serious illness
or incapacity. f. PATIENT'S BILL OF RIGHTS.
AD may provide a patient's Confidentiality or professional
personal instruction that: secrecy is both a legal and
moral obligation of health care
1. Direct a physician not to
providers to their clients.
put him on prolonged life
support if, in the future, if Means all information gathered
his condition is such that about the patient in the course
there is little or no hope of his health care by a health
of reasonable recover care professional should be
2. Specify a treatment to safeguarded from others, or
follow. should be a secret between the
3. Name a substitute professionals involved in the
decision maker, a person
patient's health care and the 4. PRINCIPLE OF FIDELITY -
patient. FAITHFULNESS The need to
KEEP PROMISES. The
PERSONS REQUIRED TO
obligation to be faithful to the
OBSERVE CONFIDENTIALITY
agreements, commitments and
 Physicians who deal with the responsibilities that one has
patient even for a briefest made to oneself and others
time at various phases of the
patient's illness for treatment
 pharmacist who prepares 5. PRINCIPLE OF JUSTICE
and dispenses the
It is the obligation to be fair to all
medication prescribed to the
people.it is based on the
patient
concept of fairness extended to
 all other health care each individual; equal treatment
professionals involved in the to all.
care of the patient such as
nurses, midwives, medical Principle of Justice - refers to
technologists, hospital a moral principle by which
chaplain, student nurses and certain actions are determined
social workers. and deemed as just or unjust, as
 all other personnel who due or undue.
attended to the care of the
Distributive Justice - pertains
patient such as janitors,
to a fair scheme of distributing
hospital receptionists,
society's benefits and burdens
secretaries, accountant,
to its members in health care
treasurer, etc
milieu. Ex. Just allocation of
WHEN CONFIDENTIALITY resources
MAY END:
Benefits - refers to various
1. After the patient gives his health care services, while
consent to reveal information burdens include the necessary
about him or his health care. payment for the delivery of
2. When its revelation is for the health care and participation in
common good medical experimental research.
3. The necessity of reporting
6. PRINCIPLE OF
medico-legal cases
BENEFICENCE
3. PRINCIPLE OF VERACITY -
 Provides that good must be
TRUTHFULNESS. The
done either to oneself or to
obligation to tell the truth.
others
 Urges everyone to do what unnecessary treatment or to
is good and perform for good a dangerous procedure
as a moral obligation. without a commensurate
 Health care practitioners important goal; and
have the primary obligation  Harming a person's
to ensure that good is done reputation, honor, property,
to their patients and clients. or interests as by revealing
 Duty to promote good confidential information

Elements: one ought: 8. PRINCIPLE OF DOUBLE

EFFECT OR THE TWO-FOLD
A. Not to inflict/evil/harm EFFECT.
B. Prevent evil or harm
C. Remove evil/harm - Principle of Double Effect.
D. To do or promote good. Action having two effects: a
good effect that is intended and
7. PRINCIPLE OF NON- a bad effect that is foreseen.
MALEFICENCE.
- This doctrine was established
 Provides that evil or harm by St. Thomas Aquinas in the
should not be inflicted either 13th century.
on oneself or on others.
 Urges everyone to avoid 9. PRINCIPLE OF
inflicting harm SUBSIDIARITY. Means that
 It mandates the right not to what an individual, lower or
be killed, right not to have smaller group can achieve within
bodily injury, or pain inflicted his/her or its capacity should not
(on) oneself, (and) right not be taken away and transmitted
to have one's confidence to the custody and performance
revealed to others. of a higher or bigger group.

Violations of the Principle of Likewise, no bigger or higher

Non-maleficence: group can arrogate to itself
functions that can capably and
 Physically harming a person competently be done by an
as in suicide, abortion, individual or lower group.
infanticide, mutilation, torture
and violence. Types of Cooperation with evil
 Exposing a person to 1. Positive and Negative
physical harm as in Cooperation
subjecting a person to
Positive Cooperation - a a human person which is
voluntarily doing an act which enjoined by both natural law and
contributes to the evil act of positive law requiring what is
another. due must be rendered to the
patient as justice demanis.
A nurse/midwife who assists an
obstetrician perform an abortion 1. RIGHT TO MEDICAL CARE
is committing positive AND HUMANE TREATMENT
cooperation.
a. Every person has the right to
health and medical care
corresponding to his state of
Types of Cooperation with evil
health, without any
2. Immediate/Direct or discrimination and within the
Mediate/Indirect Cooperation limits of the resources available
for health and medical care at
Direct cooperation happens the relevant time
when a person's cooperation
occur while the act is being b. The patient has the right to
performed. health and medical care of good
quality.
A nurse who acts as a "watch"
while the doctor injects a fatal In the course of such care, his
dose of sedative to an human dignity, convictions and
unconscious patient is integrity shall be respected.
committing direct cooperation.
His individual needs and culture
Indirect cooperation is shall be likewise respected.
committed before or after the
c. If any person cannot
evil act, however, the
immediately be given treatment
cooperation is not necessary to
that is medically necessary, he
the evil act itself.
shall, depending on his state of
A nurse destroys all evidence of health, either be directed to wait
an abortion although she did not for care, or be referred or sent
assist while the surgical for treatment elsewhere, where
procedure was being performed. the appropriate care can be
provided If the patient has to
PATIENT'S BILL OF wait for care, he shall be
RIGHTS informed of the reasons for the
delay and the estimated waiting
PATIENT'S RIGHTS - Refers to time.
the moral power incumbent
upon the dignity of the patient as
d. Patients in emergency who In cases of emergency, when
are in danger of dying and/or the patient is unconscious
may have suffered serious and/or incapable of giving
physical injuries shall be consent and there is no one who
extended immediate medical can give consent in his behalf,
care and treatment without any then the physician can perform
deposit, pledge, or mortgage or any diagnostic or treatment
any form of advance payment procedure as good practice of
for the confinement of treatment. medicine dictates without such
consent;

2. RIGHT TO INFORMED
CONSENT Who can give consent?
What is informed consent? b. Informed consent shall be
obtained from a patient
RIGHT TO INFORMED
concerned if he is of legal age
CONSENT
and of sound mind, from the
a. The patient has a right to next kin in the case the patient is
clear explanation, in lay person's incapable of giving consent, or
terms, from the parents or legal
guardian in the case of minor or
 all proposed procedures, mentally incapacitated
whether diagnostic or individual.
therapeutic,
 including the identity of the Provided, that if his parents or
person who will perform the legal guardian refused to give
said procedure, consent to a medical or surgical
 possibilities of any risk or procedure necessary to save his
mortality or serious side life, the court upon petition of the
effects, problems related to physician or any person
recuperation, and interested in the welfare of the
child, may issue an order giving
 probability of risks involved,
such consent.
and
 he will not be subjected to 3. RIGHT OF PRIVACY
any procedure without his
informed consent. a. The patient has the right to be
left alone when this will not
What if your patient is prejudice the provision of
unconscious? Or incapable of necessary medical care.
giving consent??
b. The patient has the right to be What if the disclosure of the
free from unwarranted publicity, information to the patient will
except in the following cases cause mental suffering and
further impair his health, or
1. when his mental or physical
cause the patient not to submit
condition is in controversy and
to medically necessary
the appropriate court in its
treatment?
discretion orders him to submit
to a physical or mental b. The patient has the right to
examination by a physician. know the name and credentials
of the physician responsible for
2. when the public health arid
his care or for coordinating such
safety so demand; and
care. He may likewise request
3. when the patient waived his for similarly relevant information
right. about any other health care
provider directly involved in his
4. in medico-legal cases care
4. RIGHT TO INFORMATION c. The patient has the right to
a. The patient has the right to examine and be given an
clear, complete, and accurate itemized bill for services
evaluation of the nature and rendered in the facility or by his
extent of his disease, physician and by other health
care providers, regardless of the
the contemplated medical manner and source of payment.
treatment and surgical
procedure including the He is entitled to a thorough
medicines to be administered explanation of such bill should
and he find this incomprehensible.
6. RIGHT TO CHOOSE A
 their generic counterparts
PHYSICIAN
and its
 probable outcome, The patient is free to choose the
 economic costs, physician to serve him except
 impact on lifestyle and work, when;
 including side effects and
1. he is confined in a charity
after effects of the treatment,
ward,
 possible complications and
2. he has entered into a
other pertinent facts
contract with a health
regarding his illness.
maintenance organization or
any other health Insurance
organization which stipulates described in the preceding
that the patient can only be subsection.
served by a
Provided, that such a right shall
3. Affiliated with the
not be imposed by parents upon
organization.
their children who have not
7. RIGHT TO SELF- reached the age of legal
DETERMINATION discretion.
a. The patient has the right to 9. RIGHT TO MEDICAL
refuse diagnostic and treatment RECORDS
procedures.
a. The patient is entitled to a
Provided, that summary of his medical history
condition which shall be
1. he is of legal age and of accomplished by the attending,
sound mind physician. He has the right to
2. he is informed of the medical view the content of his medical
consequences of his refusal records with the AP explaining
3. he releases those involved the contents thereof.
in his care from any
obligation relative to the
consequences of his
b. The health care institution
decisions
shall ensure and safeguard the
4. his refusal will not jeopardize
integrity and authenticity of the
public health and safety.
medical records.
b. An adult with a sound mind
c. The health care institution
may execute an advance
shall issue medical certificate,
directive for physicians not to
free of charge, to the patient
put him on prolonged life
upon discharge from the
support if, in the future, his
institution. Any other document
condition is such that there is
that the patient may require for
little or no hope of reasonable
insurance claims shall also be
recovery.
made available to him within
8. THE RIGHT TO RELIGIOUS reasonable period of time.
BELIEF
10. RIGHT TO LEAVE
The patient has the right to
a. The patient has the right to
refuse medical treatment which
leave the hospital or any other
may be contrary to his religious
health care institution regardless
beliefs, subject to the limitations
of his physical condition.
b. No patient shall be detained The patient has the right to
against his will in any health express grievances about the
care institution on the sole basis care and services received.
of his failure to fully settle his
15. RIGHT TO BE INFORMED
financial obligations with the
OF HIS RIGHTS AND
physician or the health care
OBLIGATIONS AS A PATIENT
institution
Every person has the right to be
11. RIGHT TO REFUSE
informed of his rights and
PARTICIPATION IN MEDICAL
obligations as a patient.
RESEARCH
The patient has the right to be PRINCIPLES OF
advised if the health care BIOETHICS
provider plans to involve him in
medical research, including but 1, PRINCIPLE OF
not limited to human STEWARDSHIP.
experimentation that may affect Stewardship - refers to the
his care or treatment. Such expression of one's
human experimentation may be
performed only with the written responsibility to take care of,
informed consent of the patient nurture and cultivate what has
been entrusted to him.
In health care practice,
12. RIGHT TO stewardship refers to the
CORRESPONDENCE AND execution of responsibility of the
RECEIVE VISITOR health care practitioners to look
The patient has the right to after, provide necessary health
communicate with relatives and care services, and promote
other persons and to receive health and life to those entrusted
visitors subject to reasonable to their care
limits prescribed in the rules and This principle is grounded in the
regulations of the health care
institution. - presupposition that God has
absolute Dominion over
13. RIGHT TO KNOW WHAT creation, and that, in so far as
HOSPITAL RULES & human beings are made in
REGULATIONS APPLY TO HIS God's image and likeness
CONDUCT AS A PATIENT (Imago Dei), we have been
14. RIGHT TO EXPRESS given a limited Dominion over
GRIEVANCES
creation and are responsible for Based on the PRINCIPLE OF
its care. TOTALITY.- body mutilation is
ethical for the sake of saving the
2. PRINCIPLE OF TOTALITY.
whole body or preserving life
"The whole is greater than any
of its parts" An individual may not dispose of
his organs or destroy their
The whole implies the existence
capacity to function, except to
of its part. The existence of is
the extent that this is necessary
parts indicates the existence of
for the general well-being of the
the whole,
whole body.
Parts as such should
INTEGRITY - refers to each.
continuously be connected with
individual's duty to "preserve a
the whole of which they are
view of the whole human person
parts without which they cease
in which the values of the
to be.
intellect, will, conscience and
"Each Bart only exists for the fraternity are pre-eminent"
good of the whole*
Principles’ of Integrity &
However, in its state of condition Totality
an continuous existence as part
These principles dictates that
pose a threat to do more harm
the wellbeing of the whole
than good leading to the
person must be taken into
destruction of the whole and that
account in deciding about any
there is no means by which th
therapeutic intervention or use
problem can be addressed, the
of technology.
principle of totality provides that
it be removed and sacrificed for Therapeutic procedures that are
the sake of the whole likely cause harm or undesirable
side effects can b justified only
A patient is admitted with a
by a proportionate benefit to the
gangrenous leg. The attending
patient.
doctor reasons out, based on
scientific medical basis, that Mutilation or maiming (from the
there is no other way which the Latin: mutilus) is cutting off or
patient can be saved but to causing injury to a body part of a
amputate the gangrenous part of person so that the part of the
the patient's body. body is permanently damaged,
detached or disfigured.
Question: Is it morally
permissible for the doctor to do Mutilating Surgery - is A 'heroic'
the amputation? intervention entailing massive
excision of tissue, often from a individuals Ex. Animal to human;
broadly invasive malignancy, to human to human
remove tumor and/or
metastases, regardless of ORGAN DONATION
deterioration of quality of life, The donation of organs or the
potential infection and other co- body for such purposes is
morbidity. certainly in harmony with
Mutilation - any lessening of the Scriptural to on loving and
integrity of the human body. helping our neighbor,

Major Mutilation: renders the Donations for transplants should

individual unfit for natural 'not be look upon, however, as
function. Ex. Sterilization, some way to achieve immortality
removal of tongue, etc a gesture of life to someone in
need
Minor Mutilation: does not
destroy its function, Ex Removal with the advent of organ
of tonsils or appendix. transplants, the need many body
organs has grown greatly.
Principle of Totality: all the Mostly such org (must be taken
parts of the body are ordained from people who have recently
for the good of the whole entity. died, usual within thirty minutes
Therefore: or so of death.
there is no moral violation when 3. Principle of Ordinary
it is necessary to destroy a fart
for the good of the whole. Means refers to the basic right -
and duty of’ a person in case of
HUMAN TRANSPLANTATION a serious illness to take the
surgical procedure whereby an necessary means for the
organ or tissue is transferred fro preservation of life and death
one part of the body to another,
from one organism to another Ordinary and Extraordinary
organism Means These two terms refer to
the means to. preserve life.
Types of human transplantation:
 Ordinary means are
1. auto transplantation - donor obligatory,
and recipient one and the same  Ordinary, treatment or
Ex. Skin añd bones procedure that is morally
required, such as fluids and
2. heterologous
comfort measures, may be
transplantation - donor and
called appropriate.
recipient are two different
Extraordinary are optional and the family so as to expand the
many not be chosen. human community and
guarantee its future beyond
The extraordinary may be
death; and
chosen with the hope of healing
a person or they may produce 4 Sex is a symbolic
no benefit. (sacramental) mystery,
somehow revealing the cosmic
•Extraordinary measures:
order.
procedures and treatment that
are morally expendable, such as BIOETHICS & ITS
chemotherapy, tube feedings, APPLICATION IN
CPR, and mechanical breathing
VARIOUS HEALTH CARE
or respirators may be called
SITUATIONS
appropriate,
B. DIGNITY IN DEATH AND
SEXUALITY – is complex.
DYING
aspect of our personality and
'self'. Our ‘sexuality is defined, 1. Euthanasia
by sexual thoughts, desires and 2. Inviolability of human
longings, erotic fantasies, turns life
on’s and 3. Euthanasia & assisted
4. The Principle of Sexuality is suicide Dysthanasia;
all about pleasure, love, Orthothanasia
reproduction and the 4. Administration Of
sacramental meaning of sex. Drugs To The Dying
5. DR or End Of Life Care
Basic Concepts of Sexuality Plan
Sex is a search for sensual EUTHANASIA
pleasure a satisfaction,
releasing physical and psychic is the practice of deliberately
tensions; More profoundly and easing into death an individual
personally, Sex is search for the who is suffering from a painful or
completion of the human person incurable disease or handicap.
through an intimate personal 'euthanasia is Greek in
unio of love expressed by bodily origin-"eu" means good;
union of the achievement of a "Thanatos" means death = good
more complete humanity death
More broadly, sex is a social "MERCY KILLING" is the
necess for procreation of intentional taking of the life of an
children and their education in
ailing person, for any of the patient is without the patient's
following reasons: consent or knowledge. The
patient is competent to express
 Incurability of illness his will and is able to make a
 Unbearable intensity of decision, but has not been
physical or emotional pain consulted, and his life is ended
 Unbearable financial by an act of euthanasia.
burden arising from the
illness c. Non-voluntary

Types of Euthanasia: euthanasia means that the

euthanasia is performed when a
1. by reason of the manner of patient is not competent to make
attaining death a decision, for example when
 Active or direct euthanasia the patient is comatose,
- actively taking steps by the mentally insufficient or is not
physician or the caregiver to able to express a wish, such as
end the life of the patient, a baby born with severe
such as injection of a lethal congenital abnormalities.
drug
 Passive or indirect PHYSICIAN ASSISTED
euthanasia - the intentional SUICIDE - the patient requests
omission or non- from the physician to provide the
administration of medical means to end his life.
treatment to cause or hasten Withholding or withdrawing life-
the death of the patient. The sustaining treatment simply
withholding of life-giving means that the physician
sustenance.Ex. Starving of a forgoes the life-sustaining
newborn having a congenital treatment for a terminally ill
defect, withholding of patient taking into account the
reasonable life support from patient's benefit, the wishes of
a terminally ill patient. the patient and family, and the
2. by reason of patient's life futility of treatment.

a. Voluntary euthanasia - the REASONS WHY Some may

patient consciously and directly agree with euthanasia and
requests the health care physician-assisted suicide for
provider to take the steps to put the terminally ill patient:
an end to the patient's life.  it can relieve unbearable
b. Involuntary euthanasia - the suffering of the patient
act of seeking the death of the
 it can relieve burdens from Therefore, man has no authority
the relatives; the patient to destroy life.
has a right to die;
3. EUTHANASIA & ASSISTED
 the patient can die with
SUICIDE-
dignity; and
 the limited resources can EUTHANASIA - administering a
be reallocated. substance to a person at their
request that causes their death
SLOW EUTHANASIA - is the
clinical practice of treating a ASSISTED SUICIDE -
terminally ill patient in a fashion prescribing or providing a
that will assuredly lead to a substance to a person at their
comfortable death, but not too request so that they may self-
quickly. administer the substance and in
so doing cause their own death
This form of euthanasia is end-
of-life care may be more 4. DYSTHANASIA- the
acceptable to patients, family excessive prolongation of life or
members, and health death suffered from much pain,
Professionals than rapid mercy aggressive treatment that only
prolongs the process of
2. INVIOLABILITY OF HUMAN dying .Comes from a Greek
LIFE. or sanctity of life, is a
word dys- difficult; thatandeath
principle of implied protection
regarding aspects of sentient life  In common language it
that are said to be holy, sacred, means to delay, as much as
or otherwise of such value that possible, the process of
they are not to be violated. death.
 The focus is on persisting
The Catholic Church teaches
with a cure-oriented
that all human life is sacred
treatment decision, whose
(sanctity of life) and that
payoff may prolong the
everyone has a right to life
process of death.
which should be protected and
valued at every stage. Dysthanasia is the term for
futile or useless treatment,
The phrase sanctity of life refers
which does not benefit a
to the idea that human life is
terminal patient.
sacred, holy, and precious.
It is a process through which
The sanctity of life is inherent as
one merely extends the dying
man cannot create life.
process and not life per see.
 Consequently, patients have intractable distress of a dying
a prolonged and slow death, patient) is the palliative practice
frequently accompanied by of relieving distress in a
suffering, pain and anguish. terminally ill person in the last
 When one invests in healing hours or da of a dying person's
a patient who has no chance life
of cure, s/he is actually
Palliative sedation is an option
undermining the person's
of last resort for the people
dignityFUTILE - refers to whose symptoms cannot be
anything that is ineffective or
controlled by any other means. It
incapable of producing any is not a form of euthanasia or
useful outcome.
physician-assisted suicide, as
5. ORTHOTHANASIA - refers to the goal of palliative sedation is
the art of promoting a humane to control symptoms, rather than
and correct death, no subjecting to shorten or end the person's
patients to misthanasia or life
dysthanasia and not Drugs used in end-of-life care:
abbreviating death eith that is,
subjecting them to euthanasia. The most commonly
prescribed drugs include
• Its great challenge is to
acetaminophen, haloperidol,
enable terminal patients to lorazepam, morphine, and
keep their dignity, where
prochlorperazine, and
there is commitment to the atropine typically found in an
well being of patients in the
emergency kit when a patient
final phase of a disease is admitted into a hospice
Orthotanasia seeks to deal with facility Injection that is given
the terminal patient, helping him at end-of-life
to face his destiny with greater
Morphine and other
tranquility, maintaining a medications in the morphine
distinction between healing and
family, such as
caring, between maintaining life hydromorphone, codeine and
and allowing the person to die,
fentanyl, are called opioids.
when the time comes. These medications may be
6. ADMINISTRATION OF used to control pain or
DRUGS TO THE DYING - shortness of breath
palliative sedation (also known throughout an illness or at the
as terminal sedation, continuous end of life.
deep sedation, or. sedation for
Forms of Advance Directive:
1 LIVING WILL (Instructional hospitals, depending on your
Directive) - a will in which a needs and preference.
competent adult give directions
An end of life care plan is
or instructions for future care in
document created by the clinical
the event that he becomes
team and palliative care
incapacitated due to terminal
professionals in partnership with
illness or impending death.
yourself or loved ones to make
2. MEDICAL POWER OF the end of life as comfortable as
ATTORNEY (Health Care possible.
Proxy) - names a trusted person
• End of life care includes
to act as an agent or proxy in
palliative care. If you have
making health care decisions in
an illness that cannot be
the event of incapacity
cured, palliative care makes
8. DR or END OF LIFE CARE you as comfortable as
PLAN possible, by managing your
pain and other distressing
DO NOT RESUSCITATE order
symptoms.
or DR order - is a medical order
• It also involves
written by a doctor. It instructs
psychological, social and
health care providers not to do
spiritual support for you and
cardiopulmonary resuscitation
your family or carers. This is
(CPR) if a patient's breathing
called a holistic approach,
stops or if the patient's heart
because it deals with you as
stops beating.
a "whole" person, not just
If you or your loved one is in a your illness or symptoms.
nursing home, you would need • Palliative care is not just for
to sign a DR form to formally let the end of life - you may
the nursing home's staff know receive palliative care earlier
that you don't want to be in your illness, while you are
resuscitated. Nursing home staff still receiving other therapies
are legally bound to perform to treat your condition.
resuscitation on their patients
FIRST SIGNS OF YOUR BODY
unless they have a signed DR.
SHUTTING DOWN
You have the right te express
• You may notice their:
your wishes about where you
• Eyes tear or glaze over.
would like to receive care and
• Pulse and heartbeat are
where vol want to die. You can
irregular or hard to feel or
receive end of life care at home,
hear.
or in care homes, hospices or
• Body temperature drops.
• Skin on their knees, feet, • The ethical decision-making
and hands turns a mottled process is a systematic
bluish-purple (often in the method of solving an ethical
last 24 hours) dilemma. There are several
• Breathing is interrupted by ethical models or systems to
gasping and slows until it guide people in resolving an
stops entirely. ethical dilemma.
• The following steps of the
The first organ system to
decision making process is
"close down" is the digestive
applicable in all these ethical
system.
systems:
The last organ to die in a dying
Steps:
person: The brain and nerve
cells require a constant supply 1. Collect, analyze, and
of oxygen and will die within a interpret data
few minutes, once you stop 2. state the dilemma
breathing. The next to go will be 3. consider choices of
the heart, followed by the liver, action
then the kidneys and pancreas, 4. analyze advantages and
which can last for about an hour. disadvantages of each
Skin, tendons, heart valves and course of action
corneas will still be alive after a 5. make the decision.
day.

ETHICAL FRAMEWORKS FOR

Common symptoms at the DECISION MAKING
end of life include the
The following principles and
following:
frameworks do not solve ethical
• Delirium. problems but they provide
• Feeling very tired. guidelines in assisting a nurse in
• Shortness of breath. deciding what course of action
• Pain. should be taken when faced with
• Coughing. situations at work and in her
• Constipation. professional life that have ethical
• Troúble swallowing. implications
• Rattle sound with
1. Ethical Systems &
breathing.
Principles. No ethical system.,
Ethical Decision Making theory or principle is absolute
Process
and applicable in all affected by rules set by the
situations. organizations and institutions
of which we are members.
This is because of the many
variables present, and these Institutions (hospitals) may
variables differ in every difficult also have policies which limit
situation. Even though, they are the options available to US.
not considered absolute, ethical
5. Laws. Some decisions are
systems and principles serve as
appropriately made based on
powerful action guides in what
legal considerations. If one
course of action is correct,
option is illegal, we should at
appropriate and should be
least think very seriously
followed.
before taking that option.
2. Patient's Bill of Rights. The Remember that not all that is
patient's bill of rights legal is ethical in the same
enumerate not only what the manner that not all that is
patient duly deserve but it ethical or moral is legal
also provide specific
BIOETHICS & ITS
reminders to professional
APPLICATION IN VARIOUS
health care providers of their
HEALTH CARE SITUATIONS
ethical and legal
responsibility towards their
parents. 1. HUMAN SEXUALITY AND
ITS MORAL EVALUATION
3. Professional Code of
Ethics. The Nursing Code of •Human sexuality- refers to
Ethics outlines how nurses ways in which we experience
should practice their and express ourselves as sexual
profession in an ethical and beings. Our awareness of
moral manner. It provides ourselves as females or males is
guidance for nurses with part of our sexuality, as is the
regards to her relationship capacity we have for erotic
with her patients, colleagues, experiences and responses.
superiors and the public. It
Biologically, sexuality is
also contains her commitment
defined as an aggregate of
and ethical obligation to
characteristics that differentiates
ensure that she provides safe
between the two types or parts
and efficient service to the
of the organism which reproduce
people.
by means of the fusion of
4. Institution Policies. gametes
Decisions may also be
Psychologically, sexuality is HUMAN SEXUALITY =
the behavior directly associated COMMITMENT
with the meeting of the two
genders - with copulation which  COMMITMENT consists of:
can lead to fertilization  Care
(Broadhurst 1980:3.2046).  Concern
 responsibility
 Safeguarding the other's
2. MARRIAGE value
 Responsibility to and for one
VALUE SYSTEMS FOR another
MAKING SEXUAL DECISIONS  humanizing
Although sex is a natural • human sex is dehumanizing
function, most of us choose if and when it destroys a
how, where, and with whom to person's honor, and
become sexually involved. becomes a degradation of
We face a wide array of sexual the other.
decisions: Whom should I date?
When should my partner and I
become sexually intimate? Marriage, a legally and socially
Should I initiate sexual relations sanctioned union, usually
or wait for my partner to between a man and a woman,
approach me? Should my that is regulated by laws, rules,
partner and I practice customs, beliefs, and attitudes
contraception? that prescribe the rights and
duties of the partners and
HUMAN SEXUALITY accords status to their offspring
One has the right or freedom of -Perhaps its strongest function
sexuality concerns procreation, the care
 Your right to sex involves a of children and their education
duty in others to respect it and socialization and regulation
of lines of descent.
* Sex implies moral discipline
"it is better to be a human being
Value systems provide a
dissatisfied than a pig satisfied"
framework for judging the moral
-John Stuart Millier
acceptability of sexual options.
We often approach sexual
decisions by determining
whether the choices we face are
compatible with our moral TYPES OF ABORTION
values.
1. Elective abortion or
 Our value systems-our therapeutic is the
sexual standards-have many deliberate termination of a
sources: parents, peers, pregnancy.
religious training, ethnic  Elective- are those initiated
subcultures, the larger by personal choice.
culture, and our appraisal of  Therapeutic - those
all these influences recommended by healthcare
providers to protect the
A. SEXUALITY AND HUMAN
mother's physical or mental
REPRODUCTION
health.
1. Human sexuality and its 2. Spontaneous Abortion -
moral evaluation the loss of a fetus during
2. Marriage pregnancy due to natural
3. Artificial reproduction causes
4. Abortion, Rape 3. ABORTION, RAPE

Sexual Orientations B. Rape - a sexual assault

usually involving sexu!
Asexuality is the lack of sexual intercourse or other forms of
attraction to others, or sexual penetration (vagina, anus
low/absent interest in or desire or mouth with a penis) carried
for sexual activity. out against a person without that
Bisexuality is romantic person's consent.
attraction, sexual attraction or
sexual behaviors toward both
males and females, or to more
than one sex or gender.
Heterosexuality is romantic
attraction, sexual attraction or
sexual behavior between
persons of the opposite sex or
gender
Homosexuality is romantic
attraction, sexual attraction. or
sexual behavior between
members of the same sex or
gender.